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Version 1


4. Introduction
National Context
East Sussex Issues

7. Part 1: Communicating with people who have a
learning disability

8. Communication Bill of Rights

12. Part 2: Total Communication
Who uses Total Communication?

15. Part 3: Communication Systems
16. Intensive Interaction
19. Objects of Reference
23. Voice Output Communication Aids (VOCA)
26. Makaton
29. Symbol Systems
33. Talking Mats
35. Communication Passports
38. Communication Books
41. Talkabout Books
44. Visual timetables
48. J ob Aids
51. Social Stories
53. Life Story Books

57. Part 4: How to create a Total Communication
59. Seven things you can do right now
60. Top Ten Tips

61. Part 5: Where to find out more
Further information
Local organisations and groups promoting Total

Produced by East Sussex Adult Learning Disability Speech and Language
Therapy Team (Sussex Partnership NHS Foundation Trust)
and East Sussex County Council.


This Total Communication Resource pack has been designed as a
resource for service providers and families, and anyone involved with
supporting people with learning disabilities.

This is the first version of the Resource pack. We intend to update
regularly. There will also be an electronic version available where you can
download templates, and an accompanying CD.

National Context

Overcoming communication barriers for people with learning disabilities is
a recurring theme in all government strategies.

Valuing People Now

Valuing People Now says that more people with learning
disabilities have real choice and control in their lives but we
need to support many more people with learning disabilities to
achieve this, particularly people with the highest support

Valuing People said that communication; person-centred approaches,
advocacy, service user involvement and Direct Payments are key to
delivering choice and control.

The White Paper - Our Health, Our Care, Our Say

Our Health, Our Care Our Say endorsed these principles. It
said that giving people more control means, first and foremost,
listening to them. It means giving people more control of the
policy setting process at a national and local level.


Putting People First

Putting People First has set out a range of actions for
Councils, to enable more people with social care support
needs more choice and control over their support
arrangements and their lives. For example, by making
personal budgets available to people by 2011. Good
communication with people with support needs must be the
starting point, if the vision set out in Putting People First is to
become reality.


The Foundation for People with a Learning Disability estimate (2000) that:

between 50% and 90% of people with learning disabilities have
communication difficulties;
20% of people with a learning disability have no verbal
communication skills;
80% of people with severe learning disabilities do not acquire
effective speech; and
60% of people with a learning disability have skills in symbolic
communication such as signs or picture symbols.

East Sussex Issues

The joint commissioning strategy Strong Voices, Big Ideas
(2007) is committed to improving Total Communication in East

This Resource Pack is funded by the East Sussex Learning
Disabilities Partnership Board as a sign of their commitment to
Total Communication.



The aim of this pack is to:

provide information on the different ways of communication for
people with learning disabilities and their communication partners;
explain a selection of Total Communication methods;
give examples of communication systems; and to
give practical ideas for you to try and details of further information.

We hope those who use this pack will become confident in supporting
people with learning disabilities to communicate successfully.



Communication is a basic human right for EVERYONE. The governments
white paper Valuing People Now 2008 states that everyone should have
equal access to communication.

Communication is vital to every aspect of our lives. It impacts on our
relationships, choice, control, emotions, self-esteem and self- expression.
Therefore it is fundamental to our wellbeing and quality of life.

Imagine that you a have a very limited
understanding of speech and you are unable to
express your feelings. The people around you
dont understand you. Imagine that you keep trying
to communicate in your own way but they just
keep on speaking to you.
You dont make a fuss so they sit you in a chair in
the lounge all day, everyday and they think you are
happy to sit there because you dont make a fuss.
Imagine that you try a different way of
communicating and then they say you are too
challenging to take out. So now you sit in your
chair in the lounge all day, everyday.
Reference: Total Communication Film 2009

It is essential that we have a method of communication; an opportunity
to communicate and a subject to communicate about.

In order to make communication accessible to everyone, we need to use
all the ways available to us to give and receive information.
A Total Communication approach shifts the focus away from a reliance on
spoken and written communication to a culture where gestures, body
language, signs, symbols, photographs, objects of reference and
electronic aids are used in a consistent manner to support speech or as
an alternative to speech.

Using Total Communication approaches helps people with
learning disabilities develop their understanding and expression
in order to communicate more effectively, and live the lives they

Total Communication is about building relationships and
self-esteem, getting to know each other and togetherness.
Communication is a basic human right!

Communication Bill of Rights

The Bill of Rights was written by the
American Speech and Hearing
Association in 1992.

Everyone has the right to

1. The right to be able to ask for things. The right to
show how I feel.

2. The right to be offered choices.

3. The right to say no to things.


4. The right to communicate and be with other

5. The right to information about things I want to know

6. The right to support with communication.

7. The right to be listened to.


The right to use my communication tools whenever I like.
Tools like pictures, machines and cards.

8. The right to be in a place that supports
communication between people.

9. The right to be told about things that are happening
around me.

11. The right to dignity. To be included when people talk
about me.


12. The right to communicate my way. The way that is
right for me that respects who I am and what I believe.



Total Communication is an approach, which includes all the ways we

Eye Contact
Facial expression
Body Language
Written word
Contextual clues
Signs and

Everyone communicates using at least one of the ways
mentioned above. We all communicate in different ways
and each way should be equally respected and encouraged.

Non verbal communication can be just as effective as speech. For
example: Turning your head away when someone puts a cup to your
mouth is as clear a message as saying I dont want a drink.

However, communication is a two-way relationship and it will only be
successful if the communicator and their partner are using the same

Sometimes an individuals way of communicating may be subtle and hard
to recognise. It is very important that you spend time getting to know the
person you support so they can show you and you can recognise their
personal communication patterns. This information should be shared with
all their communication partners and recorded in a communication
passport (see page 35).

Everyone who uses non verbal communication
should have a communication passport!
Who uses Total Communication?

Total Communication will help all people with learning and sensory
disabilities, and should be used by everyone who spends time with them.

Type of Total

Example of how it used

Body Language

J has limited communication and mobility. She will not co-operate
with lifting and handling if she doesnt want to do something. J is
clearly communicating to the staff supporting her that she is not
happy, they know this because J is usually co-operative. Staff
have spent a lot of time observing J and recording the ways she
communicates in her communication passport. They can now
work out what is wrong by a process of elimination.


P has autistic spectrum disorder and benefits greatly from using
photos on a visual timetable to plan his day. He is much less
anxious now he can see what is going to happen. This makes his
life is easier.

B is non-verbal and uses objects to support her understanding.
Staff show her a sponge when it is time for a bath. B can now
use her objects to make choices. Staff show B a sponge and a
shower cap and wait for her to choose if she would prefer a bath or

T has a hearing impairment and until recently found
communicating with others difficult. T had learnt to sign before he
moved but noone at his new home knew how to sign. The Speech
and Language Therapist recommended that the staff team attend
Makaton training. T now communicates really well by signing and
has grown in confidence.


Ss main method of communication is speech. However, some
people find it hard to understand her. S uses symbols in a
communication book when she is in a new situation, to help her
get her message across. It means she doesnt have to rely on
others to speak for her. It relieves the pressure and prevents
communication breakdown. For example S can use it when she
goes to the caf.

Eye Contact,
Facial expression,
Touch, gesture

R has a daughter L with a severe learning disability. R spends time
just being with L. R creates an atmosphere that is comfortable,
relaxing and she listens to the cues from L. There is no agenda
for their time together. They just enjoy being with each other.


Parents, Carers and Staff should use Total Communication approaches at
all times.

For example: facial expression is a very effective way of communicating:

A smile shows we are happy

Everyone needs to support and encourage each other to use Total
Communication. If used consistently, it will soon become second nature to
everyone in all situations. It is up to you to ensure that the people you
support can communicate in a way that is best suited to their skills and
adapt your own communication to suit.

Remember: A good relationship leads to good communication!
Good communication leads to good relationships!



Here are some examples of communication tools and systems that use a
variety of Total Communication approaches. There will be one or more
that will suit each individual you support.

Make sure you choose methods that give the right level of support and
that is motivating for them to use.

For example, symbols are small, easy to carry around and are great to
look at but can be difficult to understand. Many people will need a clearer
method such as photos. Some will find all symbolic understanding very
difficult and will always need the real object in order to understand

Others will rely on their communication partners* as their communication
tool, to help them enjoy and make sense of the world around them.

*everyone who communicates with that person e.g. family, staff, friends

object photo symbol


What is Intensive Interaction?

Intensive Interaction is an approach that can help people to connect and
communicate meaningfully with people with severe and profound learning

An approach where interactions are lead by the person with the
learning disability.
A way of being with someone. Allowing two-way interactions that are
enjoyable for the person and their supporters.
A way that is adopted as a communication approach and used at all
times in all environments.

What it isnt:

An approach for people with mild-moderate learning disabilities or
those with more advanced communication skills (e.g. speech,
symbols systems, signing).
A teaching approach to develop communication skills.
Imitating or mimicking someones noises or movements.
An approach that can only be used by professionals or within
allocated sessions during the day e.g. to be fitted in between
bowling and lunch.

Who uses Intensive Interaction?

Intensive Interaction focuses on the needs of those who are often
described as having no language or no effective means of
communicating with others.

Intensive Interaction is based on the belief that all people are able to
actively communicate at all times. People with very severe communication
difficulties, (who do not recognise meaning in words, pictures, drawings or
writing) often go unheard.

How does it help with communication?

The approach works by progressively developing enjoyable and relaxed
interaction between the interaction partner and the person doing the
learning. These interactions are repeated frequently and gradually grow in
duration, complexity and sophistication. As this happens, the
fundamentals of communication are gradually rehearsed and learnt in a
free-flowing manner.

Research shows that this approach enables the person to develop:

An increase in fundamental communication skills including eye
contact, facial expression, turn-taking and emotional engagement.

An increase in social skills a desire and ability to be with others,
taking part in and initiating social interaction and understanding
various ways in which social interaction can be enjoyed.

A way to developing shared attention into 'activities'. To allow the
person to participate in their life rather than just to comply.

An Example:

D has a severe learning disability, is very 'difficult to reach', living a
socially isolated life, She has a range of self-stimulatory behaviors and
shows no motivation to be with other people.

Ds supporters adopted this approach and started to interact with D in a
way she understood, placing no demands on her and allowing her to have
control of the session. They would repeat any facial expressions,
vocalisations and actions she used. Gradually D would try different things
such as varying the sounds she made or changing her position to see
what would happen. As supporters and D became more comfortable with
the interactions they became more natural and spontaneous. Now
supporters have found that D has a good sense of humour, enjoys being
with others and is beginning to learn new skills such as eye contact.


There are a number of organisations, networks and individuals who
offer advice and support on using Intensive Interaction.

A Practical Guide to Intensive Interaction. Nind, M & Hewett, D.
(2001) Bild Publications

Other resources:
Intensive Interaction DVD containing examples of Intensive Interaction
activities taking place in schools and adult day and Further Information

Visit the Intensive Interaction website at
Facebook intensive interaction


Residential services. It is available from

Inter-Act Now is the East Sussex Intensive Interaction Network which
has been set up to bring together people with profound and severe
learning disabilities and their carers, families and support workers
using Intensive Interaction. The Network will enable people to share
experiences, build and develop skills and provide support for those
wanting to promote an Intensive Interaction approach within services
and the wider community.

For more information on becoming part of the Network email: Angela-



What are Objects of Reference?

Objects of Reference are objects that are used to communicate a
meaning in the same way as words and pictures. They can be used to
represent anything we want to communicate: people, places, activities,
events etc. For example a cup can stand for a drink.

You are likely to be using everyday objects with the individuals you
support already. You may be saying to them we are going out while
handing them their shoes, thereby giving them a visual clue as to what is
going to happen, so they dont need understand all the words you are
saying . Objects of Reference are objects that are used in a structured
and consistent way, and used every time the activity etc is going to
happen. An object becomes an Object of Reference when the person
begins to associate it with the activity it represents.

The objects need to be carefully selected to suit each individual and
used in situations where the need to communicate exists.

They need to be meaningful to the individual. A simple link or a
strong association between object and activity/person is best. For
example, a riding hat stands for horse riding; a string of pearls
stands for mum. However what might seem a clear link to you may
not be for the person you support. Spend time observing them doing
the activity. Each individuals set of Objects of Reference will be
unique to them.

They need to be motivating to use. For example you may wish to
have an object to represent toilet but for the person you support, the
toileting procedure could be a difficult and stressful experience.
They will have no motivation to learn the Object of Reference for
toilet. Food or favourite activities are far more motivating and

Start with a few objects that represent activities/events that occur
frequently. Repetitions of use will make it easier for the user to
understand the connection between the object and its meaning.

It is vital that there is a consistency of approach. Everybody will
need to introduce the object in the same way, using the same key
words and signs. Written guidelines are essential.

Who uses objects of reference?

Objects of reference can be useful for people with communication
disabilities who do not respond to other methods of communication such
as speech, signs or pictures.
Objects are concrete and permanent and offer lots of sensory information.
They dont rely on processing verbal information or memory.
People with profound and multiple learning disabilities
People with multi sensory loss
People with sight impairment
People with short or long term memory difficulties
People with an Autistic Spectrum Disorder for whom the spoken
word has little meaning
In order for Objects of Reference to be a successful communication tool,
the user needs to be able to:
discriminate objects by touch/smell/sound;
appreciate that objects mean something;
or have some capacity to remember the meaning of an object.
N.B These skills may not be present at the beginning but by introducing
objects they will hopefully be promoted.

How do they help with communication?
Many people with learning disabilities have things happen to them.
Objects of Reference let them know what is about to happen and help
understand what is being said.
Once the objects become objects of reference the person can begin to
use them themselves to ask for activities and make choices. Objects can
be used in the form of a timetable, so the person can begin to predict the
events of the day. Objects of Reference may be the basis of an individual
communication system or the stepping stone to other systems such as
photographs and signing.
Objects of Reference need to be Meaningful, Motivating and Frequently

Examples of Objects of Reference

Type of Object Type of object

How it is Used


Real life object that
is used in the

B likes to go swimming. She uses
a swimming costume as her
object of reference for 'swimming'.
The swimming costume is
presented to B before going
swimming. This enables her to
understand what is about to
happen to her and to give her an
opportunity to accept or refuse.

Plastic beer Glass

Real life Object that
is not used in the

M has a plastic beer glass that he
can use to indicate that he wants
to go to the pub.

M does not use the object of
reference to drink from in the pub.

Piece of cushion

Partial Object /
Object with a
shared feature

E enjoys sitting in the swing chair
in the garden, which is covered in
this material. when she wants to
go into the garden, E can take the
piece of material and find
someone to give it to. This
indicates her choice to go in the
garden and sit on the swing chair.

Small rubber ring

Abstract object not
related to activity

B has a small rubber ring that he
uses as an object of reference for
going to college.

The object has been used every
time B has gone to college. B now
recognises this object represents
going to college.

References : www.oxtc,;

Sensory References:

Sensory References are similar to Objects of Reference but use sound,
sight, smell and taste as a means of orientation rather than a specific
object. It is particularly useful for those people with profound and multiple
learning disabilities with a sight impairment. Tony J ones (via pri-Liberator)
is the leading expert and trainer.

Smell Sound Taste

An example:
Ps mum visits her regularly. To let P know her mum is coming to visit; her
carers spray some of her mums perfume. Mum always makes sure she
wears the same perfume when visiting P.

Further Information:
Tony J ones trainer and expert:
Ockelford, A., (2002) Objects of Reference; Promoting Early
Symbolic Communication, London, RNIB. Available from RNIB, 4.50
'Putting objects of reference in context', an article by Marion McLarty,
published in the European J ournal of Special Needs Education, Vol 12,
No. 1 (1997), pp12-20.
Sensory References and the work of Tony J ones



What are they?

Voice Output Communication Aids (or high tech aids /
devices) are pieces of equipment that use speech that
has been electronically stored. They can range from
simple devices - a button with one message or word, to very sophisticated
devices such as the one Steven Hawkins uses. Those users with good
reading and writing skills may use a text-based system. However, there
are many people who access their vocabulary through symbols or even
photos, which can be loaded onto the device.
VOCAs can be accessed in different ways depending on the skills of the
user. Buttons, switches, head pointers and eye gaze are some of the
ways that some users access their devices.

Who uses it?
Anyone with a communication disability, however
old, may be able to use a VOCA. A person may
wish to use a VOCA if they are unable to use
speech to communicate with others. It is very likely
that they will use other non-verbal methods of
communication as well.
People with physical disabilities who are unable to
access other methods of communication (such as
signing) are able to use VOCAs. You do not need
to use a keyboard or press a button as there are
many ways to access them.
Most VOCAs require the user to understand
symbols and to be able to remember where they
can be found on the device.

How does it help with communication?

VOCAs are powerful tools as they give people a voice, which is easily
understood by all listeners. Some people rely on them 100% of the time,
others may use them at specific times when they need to be understood
by people who are not familiar with them.

It is very motivating to be able to speak out ideas and thoughts and have
control over when you speak. Those who use VOCAs speak of how
empowered they feel through using them.
VOCAs can be quick and easy to use - good for those who cannot easily
turn pages (of a communication Book for example).

Examples of VOCAs.

There are many different types of VOCAs on the market today and with
technological developments, things change quickly!
For a database of VOCAs currently on sale in the UK go to:

Big Mack


Handheld communication aid


Examples of their Use:

There are many people without learning disabilities that use VOCAs, such
as Steven Hawkins who had his larynx removed, leaving him without the
power of speech. Some examples of people with learning disabilities
using VOCAs are below.

A has speech but is difficult to understand. He uses signs and symbols to
communicate at home, along with vocalisations. However, he likes to be
independent of his carers in the community and uses a simple VOCA at
the shops to request things for himself. He can press the buttons on the
device himself, which access a few pre-stored sentences.

B has no intelligible speech and uses a symbol based VOCA 100% of the
time. He creates his own sentences and has access to thousands of
words stored in symbols on his device.

S likes to use speech but cannot be understood by those outside of his
family. He accesses words and sentences on his VOCA by using a switch
with his chin, which scans across the words that he wants.

Further Information:

If you are interested in a VOCA then always contact your local Speech
and Language Therapist team for a full assessment.



What Is Makaton?
Makaton is an approach to teaching
communication, language and literacy using
combined modes of communication.

It is not a language in its own right. Speech,
sign, facial expression and symbols are all
key components of Makaton.
It follows spoken word order and those
supporting users would always speak and
sign at the same time.

It was developed by Margaret Walker, Speech and Language Therapist
and colleagues in the 1970s to help people with a learning disability and
deafness to communicate. However, it is now used universally with a
variety of children and adults with communication difficulties.

The signs in the Makaton Vocabulary are taken from British Sign
Language (BSL).

Makaton is a registered charity. There is a formal training
programme for families, carers and professionals. Peer
tutoring opportunities and local networks for service users
are encouraged with help from the Makaton Vocabulary
Development Project (MVDP).
There are also a wide range of resources to suit educational
and social living needs.

Who uses Makaton?

Makaton is used by people with varying communication difficulties,
including those who have:

Hearing impairment.
Expressive difficulties (speech and/or language).
Memory and/ or comprehension (understanding) difficulties.

People with severe physical disabilities may not be able to sign but may
use the symbols to support their communication.

How does it help with communication?

The Makaton signs and symbols provide extra
information to speech which is visual. This assists
peoples understanding of language and supports
their expression.

It enables those people with communication
difficulties and their carers to have a shared
language of key words around daily living.
Using the signs and symbols together with speech
can prompt people to develop their verbal and
literacy skills. Research has shown that signs/
gestures are easier to learn than spoken words. In
using Makaton, people are able to develop
important communication skills.

Signs and symbols offer permanence to language that speech does not.
It can therefore help people with memory difficulties to remember and
process what has been said.

An Example:

J has a learning disability and dyspraxia. His speech is not easily
understood by others. He also struggles to understand what others are
saying to him.
He uses Makaton signs to express his ideas and choices, usually one sign
at a time. Some of his signs are difficult to read and the support workers
have written down a description of his signs and what they mean to assist
others to communicate with him. His support workers sign when talking to
him to assist his understanding of key concepts. He also benefits from
using symbols to assist making choices and on a timetable which helps
him to understand the structure of his week.


Further Information:

For more information you can contact the MVDP at:

The Makaton Charity
Manor House
46 London Road

Main office Tel: 01276 606760
Sales Order Line: 01276 606789

Registered charity: 1119819
Company registration: 06280108

Your local Speech and Language Therapy service will also be able to


What are they?
We are all familiar with symbols as they are used commonly in everyday
life, in signs, instruction manuals, washing labels etc.
Symbols are not pictures, which may show lots of information and the
focus may be unclear. Instead, symbols focus on a single concept. They
can look like the concept that they are depicting or be more abstract.
Examples of this in everyday life are:

No Smoking symbol looks like what it is describing

Tumble dry symbol abstract, its meaning needs to be learnt

Symbols can be colour or simple black and white.
There are different symbol sets that have been developed to assist
communication used in the UK. Those available are:

Widgit Literacy Symbols (previously known as Rebus)
Picture Communication Symbols (PCS)
Makaton (in addition to Signs)

The software for these symbol sets can be bought
so that they can be printed from a computer (for
example using BoardMaker). However, it is
important to be able to provide symbols for people
to use at all times. You can therefore just draw
them as and when necessary!


Who Uses Them?
We all do!!
However, some people use them specifically to assist them with
communication and literacy. These people may :
have memory difficulties;
other brain damage;
spatial/time / organisational difficulties;
be deaf or hearing impaired;
or have Autistic Spectrum Disorders.
As there are different symbol sets, people can find it confusing and
difficult to know which to use. What a person chooses to use will depend
on their needs and preference. Everyone has different abilities in sight,
vocabulary, spoken and written language.

How do they help with communication?
Symbols can help with:
Communication - making a symbol communication book can help
people make choices. The PECs (Picture Exchange Communication
System) uses symbols, so instead of words, PECS uses pictures or
symbols of objects, such as someones favourite food. The system
slowly trains the person so that they can swap a picture of the thing
that they want for the real thing.

Independence and participation - symbols aid understanding which
can increase involvement, choice and confidence.


Literacy and learning - symbol software encourage users to "write" by
selecting symbols from a predetermined set in a grid.

Creativity and self expression - writing letters and stories and
expressing your own opinions. The Talking Mats approach also often
uses symbols to allow people to explore and communicate their
feelings and opinions about certain issues.

Access to information - all of us need accessible information and this
should be presented in such a way that the reader can understand and

Examples of Using Symbols:
Each week, P is helped by his carer to write a shopping list in symbols. He
then independently goes to the shops and is able to purchase the items
from the list despite not being able to read text.
J is a carer in a home for people with learning disabilities. Whenever she
is on holiday she sends a postcard to the residents, drawing symbols next
to the text that support the residents to read for themselves what she is
doing whilst she is away.
H is a Speech and Language Therapist in a multidisciplinary team. She
uses symbol sets on the computer to support the written word in letters to
those people who are unable to read.
L uses a communication book which has symbols in categories for her to
point to in order to communicate with others.
J has a timetable on the wall, which uses symbols to depict her activities
for the week.

Further Information:
Rebus/ Widgit



Developed by The AAC (Alternative and Augmentative Communication)
Research Unit at The University of Stirling, Scotland.

What is a Talking Mat?

It is a low-tech communication framework designed to assist people with
communication difficulties to express feelings, choice, or arrive at a
decision. A talking mat uses a three point visual scale (can be less or
more) placed at the top of the mat, and a topic which is placed at the
bottom. Options are offered one at a time to the person and they can
place them on the mat, or eye point to indicate their general views.

Who uses Talking Mats?

Talking Mats have been found to be effective with children, adolescents
and adults with expressive difficulties and those who have a mild to
moderate learning disability.

How do they help communication?

A person does not need speech to use a Talking Mat and therefore it can
give a person a voice. The tool also supports comprehension, as it gives
information to someone in different ways i.e. in a visual way, in a tactile
way and also through auditory channels. As Talking Mats uses a simple
structure, it gives a person time to process what is being asked, organise
their thoughts and then respond with what they feel in a visual way.
Photographs, pictures or even objects can be used and therefore a mat
can be tailored to the persons level of understanding. A permanent
record of the persons opinions, choices etc can also be made by taking a
photograph of what they have said. This helps the person to feel that their
views are valued and will be remembered.

Example of a Talking Mat using symbols

K has her review coming up and wants to be actively involved in the
She used several Talking Mats to discuss her life now and her future
wishes. Her key worker has taken a photograph of each mat for K to
present at her annual review meeting.

About Me Now

Visual Scale

Other examples of when talking mats might be used with someone with a
learning disability, might be to explore feelings about moving home, likes
and dislikes, future goals etc. They can be used in a persons review, to
aid person centred planning or to make a complaint. Talking Mats are
also used to support adults with learning disabilities understand direct
payments, the direct payment communication toolkit now includes the
use of Talking Mats alongside other low-tech communication aids.

Further Information

Visual Scale:
(yes, maybe, no)
Options: relate
to the topic
Topic: What you want to talk


Communication Passport

Developed by Sally Millar 1991 , Communication Aids for Language and
Learning ( CALL) Centre at the University of Edinburgh.

What is a Communication Passport?

A Communication Passport is a simple and practical guide to
understanding and supporting a persons communication. It is a book
using words and pictures to describe a person in a positive way. It should
contain the key information the owner would want to tell when introduced
to a new person, for example likes and dislikes. The reader should quickly
be able to know the best ways of communicating with that person and get
an idea of their personality as well as their everyday needs.

What it is not

Communication Passports are not intended to replace care plans.
They do not contain all the important information about an individual, just
non confidential, need to know information, in an easily accessible format.

A Communication Passport should not be confused with a Communication
Book. They are not used by the individual to communicate directly but as
a guide to others on how the individual communicates and how best to


Who uses them?

Communication Passports are for people who are unable to tell you about
themselves and need support with their communication. There are
particularly useful for those people with complex needs whose
communication is hard to read.
Communications Passports are invaluable during transition when the
individual will be meeting new people. For example when:

Moving from one service to another.
Moving home.
They use more than one service.
Where the staff turnover is high.
Hospital admissions.

How can they help with Communication?

Communication Passports can be very useful in helping new
staff/strangers to quickly understand personal needs and to ensure a
consistency of approach. They can also help to avoid preventable
behavioural difficulties
The passport should go everywhere with the person especially when they
attend anywhere for the first time (start a new place) e.g. day centre,
college. This is because they can provide a focus for attention and

Who should make one?

It can be anyone who knows the person well. But the most important thing
is to involve the person, where possible, from the beginning on what they
want to be included. Collect information from the person, and all their
supporters (family, friends and carers), circulate a draft and agree final


How do you make one?

A passport can be any colour, size or shape. It can be as simple or
complex as needed. Use your imagination. Whatever the design it should
be attractive, colourful, accessible and positive, not jargon-ridden or

They can be hand written. Use different coloured paper, pens, pictures of
the person, their friends and family, symbols or pictures of everyday
objects. Cut up old catalogues or buy a cheap picture dictionary. You
dont need access to a computer to make a passport. Hand written
passports are just as effective. They should be reviewed at least once a

An example:

G is non-verbal, uses a wheelchair and has complex health needs. He
likes going out and about, and particularly enjoys travelling by train. He is
due to go into hospital soon.
G has a communication passport in the shape of a train that he carries
around in a bag on his wheelchair. It contains a short account of Gs
communication skills and needs. G will take his passport to hospital. It will
give the nurses and all those people new to him, all the information they
require to communicate with G and understand his needs.

Do you need more information?

Personal Passports, Information Sheet 5 has many tips and ideas.
Contact Sally Millar, Call Centre, University of Edinburgh, Patersons
Land, Holyrood Road, Edinburgh EH8 8AQ. 0131 651 6236.

First Steps, Communication Matters c/o The Ace Centre, 92 Windmill
Road, Headington, Oxford, OX3 7DR. 0870 606 5463.

Please contact your local speech and language therapist for further


What is a Communication Book?

A Communication Book is a low-tech communication system that can
replace or support speech. It can contain photos, symbols, magazine
pictures or line drawings to represent daily activities, food, places objects
likes and dislikes that the owner may wish to communicate. They are
many different designs from a simple sheet with a few pictures to a book
full of symbols.

Who uses Communication Books?

Many people can benefit from using a Communication Book:

People who have no speech, limited or unclear speech.

A person whos physical disability prevents them from using other
communication systems.

People who use Voice Output Communication Aids might use a
Communication Board or Book as a back-up. For example at the
swimming pool.

The additional pictorial support can help those people who
generally make themselves understood but have difficulty in
unfamiliar situations when they are under pressure and when
communication breakdown can occur.


How can Communication Books help with

A person with limited speech can use their Communication Book to help
tell people what they are feeling, make choices and ask for what they
want. For example when asked what they want to do after lunch they can
point to a picture of walk to indicate theyd like to go for a walk.

The pictures can help the listener key into the topics being communicated.
This will decrease any frustration and promote successful interactions.
Having access to an effective means of communication will encourage the
user to communicate more.

A Communication Book can enable its owner to be more independent and
sociable, for example using it to chat with friends at a club. People may
have a book that they use to communicate a single topic or activity.
Alternatively others may use a book that covers all aspects of their life
with many different sections.

Tips on making a Communication Book

Keep it simple. Start with just a few photographs and gradually add
to the book. Ensure everyone can understand what the pictures
represent. Write what the picture means underneath it.
Start with pictures that represent a frequent or regular activity when
the need to communicate exits but only include pictures that the
owner wants to communicate. Where possible get the user to make
the book with you. Remember that they have ownership!
A small photograph album is ideal and can be carried around in a
handbag or bum bag. Alternatively pictures can be put in a ring
binder, business card folder or on a key ring.
Include an index page and divide pictures into categories. It will be
easier to use e.g. food, places and activities. Consider colour coding
sections so they are easy to find.


Consider physical or visual difficulties. Can the owner turn the pages
Keep a copy.
Keep changing and updating.
Support the person to learn how to use the book effectively.
Model using it.
Aim to be consistent. Ensure all staff know about the book and
encourage the user to use it regularly. Written guidelines may be
Dont lock it in a draw!

An example

T uses speech as his main method of communicating. He is very
independent and likes to use the bus and go shopping locally.
However Ts speech is unclear and he has difficulty making himself
understood with people who dont know him well. This makes T very
frustrated and reliant on staff to communicate on his behalf, especially
when he is out. None of his housemates have communication books so T
is reluctant to use one and he felt it was too big to carry around.

T now has a key ring with set phrases and symbols representing activities
and topics he wants and needs to communicate. The staff at his home all
have key rings and use them to back up their speech and have adopted a
Total Communication approach for everyone. T now takes his key ring
everywhere and thinks it is cool!

Further Information



What is a Talkabout Book?

A Talkabout Book is a book of photos and paper reminders to record
events and achievements, activities or things that are of interest to its
owner. It can include family photographs, holiday mementos, drawings,
tickets, programmes etc.

Who uses Talkabout Books?

Talkabout Books are useful to all people with a communication disability.
They are particularly beneficial in promoting expression. For example, a
Talkabout Book can encourage a person who is verbal, but does not
speak much to talk, about the people and events that are pictured in the
book, as well as opening up discussion on future entries.

They can be great fun too!

I went to the beach with Anna
I liked the boat
I had a strawberry
ice cream cone
It was
I saw lots
They were
It was hot and sunny
We went paddling in the sea!


How does it help with communication?

A Talkabout Book can be used as a prompt to increase opportunities for
shared communication. It helps focus the persons communication and
helps cue in the communication partner to what the person is talking

Tips for making a Talkabout Book

The individual should be as involved in creating the Talkabout Book
as their abilities allow. Whatever is entered into the book should be
interesting to them. They will not be motivated to talk about events
that they find tedious.

Parents/Staff / carers should label each picture preferably with the
wording the individuals have said themselves. Make sure the names
of all the people in photos are included. Staff should then encourage
them to chat about each picture.

Ideally the owner should have opportunities to look through their
book with others whenever the mood takes them, in an informal and
unstructured way. However if this is not possible, at the very least
staff should plan to have regular sessions (at least 1) per week,
which will be written into the weekly timetable. The length of the
session should take into account the individuals concentration span.

It may be helpful to have photographs for events that the owner
dislikes (e.g. dentist visit) so that they can talk about them. However
there needs to be many more favoured activities and events
pictured than non-favoured ones.

Guidelines should be written up to ensure consistency of use.

A Talkabout Book should be ongoing and updated regularly.

Invest in a digital camera!

Example 1

D is very quiet and rarely initiates conversations. She spends most
weekends with her parents and has regular hoildays. Staff and parents
alike have no idea what D has done when she is away from them. A
communication book between home and parents was introduced but this
is often used to talk about practical issues and problems.

D uses a Talkabout Book to record interesting activities she has done at
home and with her parents. She really enjoys making it with staff and her
parents and it give her an opportunity for 1:1 time, which encourages her
to talk more. D adds a sheet of paper into a clip file. These pages are
laminated to make them hard wearing. She recently received a digital
camera for her birthday so she can now download photos quickly and
produce a sheet at the end of the day. D is very proud of her book and it
has helped her have the confidence to approach people and start up a

Example 2

K is non-verbal but enjoys communicating with people. He has many
interests and hobbies and is keen to share them with others.
K has several Talkabout Books on topics that interest him. For example
one is about steam trains. Staff have allocated regular times to look at
these with K. These times are recorded on his visual timetable. K really
enjoys these sessions and he particularly likes to show new /agency staff.
They find this a useful way of breaking the ice and getting to know K.

I went on a steam train at
Bluebell Railway with Helen

This is my ticket

Both D and K have ownership of their books and keep them in their
bedrooms. They have the opportunity to look through their books
whenever they wish.


What is a Visual Timetable / Planner?

A Visual Timetable/ Planner uses photos, pictures, symbols or objects
placed in a sequence to represent daily activities.
They show the user what is happening and can represent part of the day,
a whole day, week or month.

Who are they for?

Everyone can benefit from having a visual reminder of what is happening.
It is a permanent record of events and does not rely on the understanding
and processing of language or memory.
People with limited understanding will find it difficult to process lots of
information at once. A timetable will clearly show them what happening
next one step is at a time.
The timetable can represent part of the day, a whole day or a week. You
will need to use appropriate timescales for that person.
Monday Tuesday Wednesday Thursday Friday


How can it help with Communication?

A Visual Timetable gives the user more control and predictability over
their daily life. It can give them opportunities to make choices and
encourage communication.

It can help people who do not understand the concept of time. A picture
of key routines such as breakfast, lunch and bedtime can be permanent
and used every day. The spaces/boxes in between can be filled daily to
show activities, tasks etc. For example it can show that on Monday after
breakfast they will go for a walk and after lunch they will be going
swimming. On Tuesday after breakfast they go shopping and after lunch
they go bowling.

A timetable can help by showing waiting.
Waiting for something to happen can be difficult for
some people causing great frustration. A timetable can
show that they have to do certain activities before they
can go out.

The pictures can be used to explain things that are not
happening .If an activity has been cancelled the
corresponding picture can be removed or covered over.
This is helpful when the user does not understand
negatives i.e. if you say you are not going for a walk
they will only understand going for a walk. If a picture is
not there or covered over this shows visually something
is not happening.

Tips on making a Visual Timetable

Keep it clear and simple. The timetable needs to be presented in a
way the user understands. Choose simple pictures that they can
recognise. Photographs of them doing the activity are very clear.

Use appropriate timescales for the individual user. For example
some people may only be able to cope with a simple time table
showing what they are doing until lunch others may have one that
shows their whole week.


The timetable should be placed in a convenient place where others
cannot tamper with it.

Consider the format. This will depend on the user. Consider the size
of the pictures and how many spaces youll need.

It is best to start with a simple daily plan with just a few spaces for
activities. As the user becomes familiar with the concept you can
increase the number of activities and days etc if appropriate.

Ideally the timetable should be prepared at a set time each day,
either last thing at night or early in the morning routine. It should
be made part of their daily routine with staff setting aside adequate
time to help the user plan their day.

When an activity has finished the pictures can be turned over or
removed (and place in a safe container so they are not mislaid).

When offering choices make sure that only activities available are
offered. For example: Going out in the car when there is a driver on

If you decide to laminate the pictures a matt finish is best, gloss
interferes with the clarity of the picture.

Use Velcro to attach the pictures. It is easy to use and reattach

Example 1:

P uses Objects of Reference to communicate. He has many objects that
represent his daily activities. If P wants to go out he shows staff his object
for going out. However, if it is not time and Peters request is denied he
has to wait. Peter gets very upset when he has to wait and often lashes
out at staff.

P now has a board that is divided into sections placed on a shelf in his
bedroom. A bowl is placed on the first section to represent breakfast. On
the next section is his object of reference for his morning activity and on
the third is a plate to represent lunch and so on. P helps to plan his day by
placing his objects on his board each morning. P now knows what order
things are happening and is able to choose what he wants to do.


Example 2:

J goes to college. At first J was keen to go but now often says she does not want to.
She told her mum that she finds college life difficult. J s mum met with her teacher
who said that J is often late for classes. When she is confronted by the teacher J
becomes upset.

J now has a symbol timetable that she carries in her back. It shows her where she is
meant to be and when. For example: the symbol of a spoon and bowl shows J it is
time for cooking class.

J is now on time for classes and enjoys college. She has a timetable for the whole
week. This means she can look forward to her weekend and tell others what she will
be doing.



What are Job Aids?

J ob Aids are visual reminders of what you are going to do. They are
guides that show the user what steps they will need to take in order to
complete a task. The tasks can range from simple dusting to making
J ob Aids can be made using photographs, pictures, symbols or on a
single laminated sheet or in the form of a booklet, showing each step on a
different page. Objects can be used in the same way. The objects needed
for a task can be place in order or on a tray to show what needs to be
done one step at a time.

Who uses them?

J ob Aids are really useful for anyone who is learning a new skill or task.
People with limited understanding find it difficult to process lots of
information at once.


A job Aid will break a task down into easily to manage steps and reduce
the need for prompting and input from others.
They are especially useful to people who have processing or memory
difficulties or who are not able to sequence events.

How do they help with communication?

A J ob Aid visually communicates what needs to be done. It is a
permanent record and does not rely on the understanding and processing
of language or memory.

A J ob Aid can increase:

predictability ;
consistency; and
self esteem.


S has moved into her own flat and receives staff support for a limited
period each day. S has worked really hard for this to happen and wants to
show people she is capable of running her own home. However she is
struggling to complete some household tasks successfully and uses up
her staff time on this. S would prefer staff to help her with money
management and supermarket trips. Her occupational health assessment
highlighted that S has some sequencing difficulties.

S has J ob Aids to help support her with her household chores.
Photographs show her what equipment she needs and each step that is
needed to complete the task. S is really happy she can do these on her
own and can now choose how to spend her staff support time.

Polishing the mirror
You will need:
Spray polish Mirror Duster

Polishing the mirror
Spray the polish
on the mirror
1 squirt
Wipe the polish
off the mirror
3 wipes
All clean!
Now put it all away!



Social Stories were developed in the early 1990s by Carol Gray
Consultant to Students with Autistic Spectrum Disorders in J enison,
Michigan, U.S.A

What is a Social Story?

A Social Story is a short story written in a specific style and format. The
story describes what happens in a specific social situation, that may be
obvious to us but not to people with impaired social understanding. It aims
to improve their understanding of social situations and encourage
appropriate responses.

Social Stories use 3 types of sentences: descriptive, perspective and
directive that need to be balanced carefully. Gray (1994) recommends a
ratio of 0-1 Directive sentence to 2-5 Descriptive or Perspective
Social Stories use a mix of writing / pictures / symbols to match the
understanding / language / vocabulary levels of the person.

Who uses Social Stories?

They were originally developed for students with autism spectrum
disorder, but have proved beneficial to others with learning, emotional,
cognitive and communication impairments.
Social Stories are versatile and easily tailored to meet a variety of needs.
However each story is unique and written for a specific individual about
a situation they find difficult.

How can they help with Communication?

Social Stories provide accurate information about real and relevant
situations. They present information visually and do not rely on
interpersonal contact. They are a prompt about how to respond and what
to expect in a specific situation. They have clear goals and give
reassurance and positive feedback.


Social Stories are often used to develop appropriate behaviour:

They describe what people do.
Why they do it.
What are the common responses.

S has an autistic spectrum disorder and finds many social situations
difficult. She refuses to go to the doctor but has ongoing health

S, her key worker and the Speech and Language Therapist have
worked together to produce a social story about S going to the
doctor. It is a positive book with one piece of information and
photograph per page. It describes what will happen at the doctors:
who will be there, what they will do and why. Ss feelings and what
she will try to do when she is there.

Further information
A successful Social Story needs to be written and delivered using a
specific formula. They need to be based on careful observation and
assessment. Your local Speech and Language Therapist will be able to


What is a Life Story?
A Life Story book is an account of a persons life, including stories and
memories of past events and relationships all the kinds of experiences
that make us, who we are. (Helen Hewitt 2006)
A life Story can take many forms:
a book
a video diary
Spoken interview
a time line
a family tree
a memory box
a poster

Who uses life Story Books?
Life Stories can benefit everyone at all levels of ability.
Identity is what makes us unique. People with learning disabilities are
often denied the opportunity to consider who they are and how life events
affect their identity. (Helen Hewitt 2006)
Many people with learning disabilities are faced with many moves over
their lifetime and much of their life history has been forgotten, archived or
A Life Story Book can help the person with a learning disability regain
their unique life story and help carers and staff appreciate them as
individuals not just as person with a learning disability.

How do they help with communication?

Life Stories are a great way of getting to know someone. They provide a
focus for interaction and an opportunity to promote communication.

Life Stories can be very useful:

when preparing someone for a life change;
for people with dementia,
memory difficulties;
where staff turnover is high;
when meeting new people; and
to enable the person to have an identity other than learning

J anuary 2008
Sue broke her leg
She needs to
move into a
home that doesnt
have any stairs
February 2008
Sue looks at flats
and bungalows
February 15
Sues review
bungalow found
that Sue likes
All agree to move
March 2008
Sue visits new home
and packs
ready for move
Life Story for Sue moving to a new home
Moving date: 28.3.08
House warming party!
April 26
J anuary 2008
Sue broke her leg
She needs to
move into a
home that doesnt
have any stairs
February 2008
Sue looks at flats
and bungalows
February 15
Sues review
bungalow found
that Sue likes
All agree to move
March 2008
Sue visits new home
and packs
ready for move
Life Story for Sue moving to a new home
Moving date: 28.3.08
House warming party!
April 26

How to implement them?
Before starting a Life Story for someone you support, carefully consider
the following:
Benefit to the individual.
Building trust with family/friends/past carers.
Sensitive handling of personal information.
Dealing with upsetting/traumatic past experiences.
Together, decide the best way to set out the persons life story. Collect
information/pictures/photographs/interviews from the person and all other
sources. Have fun putting it together!

If there arent any contacts or written history available start a life story
using the information you do have. Record life events that have
happened since you met and continue to build on this. Include hopes and
future wishes.
Life Stories are ongoing and should be continually updated.
1.) B has lived in many care homes since his childhood. His parents are
dead and he is not in contact with his extended family. B has limited
communication and little of his past history has been passed on and
Staff discussed the idea of a life story with B and got his consent to
contact past carers and residential staff. They wrote to the carers outlining
their aims and were able to gain some important information. A bonus
result was an old key worker of Bs visited him and they were able to
enjoy catching up. B enjoyed hearing stories about himself.
Staff and B made a poster for his bedroom wall. It represents Bs life story
and shows who he is and what is, and has been important in his life.

2) M has an elderly mum who is terminally ill. She has no other family
Ms support staff have sensitively introduced the idea of a life story book
with Bs mum. They made sure mum was clear of the benefits for B. Mum
recorded stories of Bs childhood and the family history. She gave B
photographs and some personal belongings that will help B remember her
in the future when she is no longer alive. B and her community support
key worker made a memory box. B enjoys going through her memory box
with mum and her support staff.
Further Information

Life story books for people with learning disabilities
Written by Helen Hewitt, Bild publications 2006
This book is an excellent resource for all those considering
starting a life story work.



It is important to create an environment that enables an individual to
communicate to the best of their abilities.

A successful environment needs:

The individuals communication partners to spend time with the
individual getting to know their preferred method of communication.

skilled communication partners who are able to adapt their
communication skills to meet the needs of the individual. For
example use simple speech;

a predictable, consistent environment to live in. Many people with
severe learning disabilities will derive a lot of understanding from
environmental cues and routines;

to use all the appropriate Total Communication approaches
consistently and in all aspects of daily life. For example gestures,
visual support, body language; access to communication aids and
resources e.g. visual timetables, communication books and
talkabout books.

Different methods or a mixture may be required in different
situations. For example using a social story when going to the


to provide opportunities to engage in meaningful conversation and
participate in decision making;

to be a suitable physical environment for example, room layout;
correct lighting and reduced background noise.

hearing and visual impairment have a major impact on
communication skills. You need to alter your skills accordingly and
ensure the environment is suitable.
Ensure people are formally assessed on an annual basis. Check
that glasses and hearing aids are in good working order.

1/3 people with learning disabilities are likely to have a sensory
impairment sight and/or hearing loss.

Everyone in the household / work place will benefit from clear
communication. For example, even people who can read will find that
additional pictures will help focus and clarify the written and spoken word.

Total Communication is for everyone!



1. Respond to all attempts at communication.

2. Spend time getting to know the people you support / care for.
Communication time shouldnt be timetabled into peoples
days. Communication is present in everything we do!

3. Make a commitment to change your communication. Have
time allotted to implement and discuss these changes.

4. Make a staff photo and residence photo board. This can
show who is on duty, in or out etc.

5. Menu planners using photographs or symbols. This gives
people better opportunities to choose their meals.

6. Make a communication passport for all those people who are
non-verbal. See page 35.

7. Buy a digital camera and/or a video camera. This is useful
for making communication aids and recording memories.

Make good communication your top priority!


Communicating with People with a learning disability

Top Ten Tips!

1. Make sure you have their ATTENTION before you start.

2. Speak SLOWLY and CLEARLY.


4. REPEAT yourself.

5. Give them time to understand.

6. Only give ONE piece of information at a time.

7. Demonstrate where possible.

8. Use a CALM and QUIET environment.

9. Check their UNDERSTANDING (ask them to tell you
what youve said in their own words).

10. Use OTHER ways of communicating like DRAWING,



Further Information




Foundation for People with learning



Local Organisations and groups promoting Total

Frameworks 4 change

Project Artworks


Involvement Matters Team



TC Partnership
East Sussex